Effectiveness of sexual health services

We look at the effectiveness of sexual health services in England.

Indicator

Last updated: 31/03/2022

Effective clinical care
Primary and community care Public health

Background

Sexual health promotion and the provision of sexual and reproductive health and HIV services make an important contribution to both individual and population health. Sexually transmitted infections (STIs) are often asymptomatic. If left untreated, they can cause pelvic inflammatory disease or infertility, and may be transmitted to others. This highlights the need for early detection and treatment. The burden of STIs is not evenly distributed, with some communities disproportionately affected, including people living in poverty, specific ethnic minority communities, and people living with HIV.

National lockdown and local lockdowns implemented as part of the government’s Covid-19 pandemic response has caused disruptions to sexual health services (SHSs). In 2020, there were 1.6 million sexual health screens (test for chlamydia, gonorrhoea, syphilis or HIV) delivered by SHSs, a 25% decrease compared to 2019.


How have the rates of new sexually transmitted infection diagnoses changed over time? 31/03/2022

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In 2020, there were 317,901 new sexually transmitted infection (STI) diagnoses made at sexual health services in England, a 32% decrease on 2019. Of these, the most commonly diagnosed STIs were chlamydia (161,672; 51% of all new STI diagnoses), gonorrhoea (57,084; 18%) and genital warts (27,473; 9%).

In 2020, rates of new diagnoses per 100,000 population decreased for all STIs, however this is in light of a 25% decrease in sexual health screens compared to 2019. Between 2019 and 2020, the biggest decline in rate of new diagnoses was for genital warts, a 47% decrease from 91 to 48 per 100,000 population. Syphilis had the smallest decline in new diagnoses at 14%, from 14 to 12 per 100,000 population. 

Prior to the pandemic, the observed rising trends in STIs may be attributed to both more routine testing and case finding in genitourinary medicine and sexual and reproductive health services, and also to continued unsafe sexual behaviour. For example, it is likely that condomless sex associated with HIV seroadaptive behaviours is contributing to the increases in syphilis amongst men who have sex with men (MSM). Of increasing concern is the rise in gonorrhoea diagnoses, especially within a context of antimicrobial resistance for this STI.


How has the proportion of the population aged 15 to 24 screened for chlamydia changed over time? 31/03/2022

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The National Chlamydia Screening Programme (NCSP) provides screening to sexually active young people aged 15 to 24 years, with the aim of increasing the detection of chlamydia and reducing the prevalence of associated health outcomes. In 2020, more than 950,000 chlamydia tests were carried out among young people aged 15 to 24 years in England, a 30% decrease from 2019. A total of 93,545 chlamydia diagnoses were made among this age group.

Assuming one test per person, the proportion of the population aged 15 to 24 screened for chlamydia decreased from 27% in 2012 to 14% in 2020. The number of diagnoses per 100,000 people aged 15 to 24 years (the chlamydia detection rate) declined in the past year, from 2,058 in 2019 to 1,420 in 2020. The Department of Health’s Public Health Outcomes Framework recommends that local areas aim to achieve a chlamydia detection rate among 15- to 24-year-olds of at least 2,300 per 100,000 people.


How has the proportion of late HIV diagnoses changed over time? 31/03/2022

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A key strategic priority is to decrease HIV-related morbidity and mortality by reducing the proportion and number of HIV diagnoses made at a late stage of infection. People who are diagnosed late are estimated to have lived unknowingly with HIV for 3-5 years and have a ten-fold risk of death compared with those diagnosed promptly. Historically, the definition for a late-stage HIV diagnosis was a CD4 (a type of white blood cell crucial to your immune system) count of less than 350 cells/mm3 within 91 days of diagnosis. However, a proportion of diagnoses classified as late are made while a person is undergoing seroconversion, an illness that can happen six weeks after initial infection, which also lowers a person’s CD4 count. A mis-classification of a recent infection as a late infection can happen in groups who are likely to test frequently for HIV.

In 2020, new data was published dated back to 2011 which better accounts for the ‘seroconversion effect’. Under this new definition, between 2011 and 2020, the proportion of people in the UK diagnosed with HIV at a late stage of infection decreased from 43% to 36%, with the absolute number falling from 2,143 to 742. 

The overall decline in late diagnosis is attributable to reductions in late HIV diagnoses among heterosexual men (from 63% in 2011 to 48% in 2020), heterosexual women (from 54% to 42%), and men who have sex with men (MSM) (from 43% to 35%). Although the highest number of people diagnosed late is among MSM, HIV cases that are diagnosed at a late stage of infection remain a significant concern among gay and bisexual men and people of Latin American and West African ethnic origin, especially women. 


How has the number of consultations carried out by sexual health services changed during the coronavirus (Covid-19) pandemic? 31/03/2022

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Sexual health services provide testing and treatment for STIs, as well as advice and information to prevent transmission. In 2019, the number of consultations carried out by sexual health services each month (excluding consultations exclusively for HIV care and consultations for prisoners) fluctuated at around 200,000. Between February and April 2020, the number of consultations almost halved following the onset of the Covid-19 pandemic, from 200,577 to 109,505. By June 2020, the number of consultations had recovered to 168,360 but was still 11% lower than in June 2019. 

The number of STI diagnoses follows a very similar trend to the number of consultations. For example, the number of gonorrhoea diagnoses show peaks and troughs in the same months as consultations occurred. Gonorrhoea diagnoses fluctuated at around 3,000 per month pre-Covid, and fell to 1,707 in April 2020 (data not shown).

Note that this data is provisional – see ‘About this data’ below for more information.

About this data

The diagnosis rate of an STI is defined as the number of diagnoses among people accessing sexual health services (SHS) in England who are also residents in England, expressed as a rate per 100,000 population. 

The data represents the number of diagnoses reported and not the number of people diagnosed. Rates were calculated using Office for National Statistics (ONS) population estimates for 2016. Note that the data for chlamydia from 2012 onwards is not comparable to data from previous years (from 2008-2011 the data related to those aged 15-24 and from 2012 onwards the data related to those of all ages). Further to this, the diagnosis totals for the other STIs from 2012 onwards include data from specialist SHS (level 3) and non-specialist SHS (level 2) so are not comparable with data from previous years.

The chlamydia tests data includes those carried out on people aged 15 to 24 years inclusive. The data represents the number of tests and diagnoses reported, and not the number of unique people tested or diagnosed. A maximum of one chlamydia test per individual is counted within a six-week period, and the data presented is based on tests with confirmed positive and negative results only.

Late diagnosis of HIV in adults is defined as those aged 15 years and above who are diagnosed with a CD4 cell count <350 within 91 days of diagnosis in the UK.

For more information on these statistics, please see Public Health England's Sexual and Reproductive Health Profiles.

This indicator uses data from the UK Health Security Agency on sexual health services and diagnoses of sexually transmitted infections (STIs).

Data on consultations carried out by sexual health services during the Covid-19 pandemic is provisional. During the pandemic, the number of sexual health services that submitted data decreased, and only consultations for services with complete data for January to June 2019 and January to June 2020 are presented here. For more information, see the Public Health England report Impact of COVID-19 on STIs, HIV and viral hepatitis in England: 2020 report (provisional data) and the appendix.

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